Replaces, revises, and simplifies Stage 2 and 3 Medicare Meaningful Use requirements, with a greater focus on performance.

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1 MIPS Scoring Guide How to succeed under the new CMS payment model The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 enacted a new Medicare payment model to reward physicians and other clinicians for delivering better care, not more care. The MACRA Quality Payment Program (QPP) provides two paths that link payment updates with value-based requirements: The Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (A-APM s). MIPS will begin in performance year 2017, and Eligible Clinicians (ECs) or groups participating in MIPS will receive an upward, downward or neutral payment adjustment starting in This adjustment is based on a MIPS Final Score reflecting performance in four categories: Quality Carries over many of the existing quality measures from PQRS and Meaningful Use and adds a few new measures. Focuses on outcomes and other high priority measures. Advancing Care Information (ACI) Replaces, revises, and simplifies Stage 2 and 3 Medicare Meaningful Use requirements, with a greater focus on performance. MIPS Final Score These categories are weighted and then combined to create a MIPS final score. After all reporting is completed and scored, the Centers for Medicare & Medicaid Services (CMS) will use a threshold 1 after the first reporting year, a mean or median of the composite performance scores for all MIPS-eligible professionals against which all ECs will be compared to determine annual payment updates. Improvement Activities (IA) A new component that enables ECs to choose a small number of activities from over 90 practice improvement activities that align with your own practice improvement strategies and capabilities. Cost Builds on Value-Based Modifier program cost of care measures. This category doesn t require data submission because it will be calculated based on claims, and it will not count toward your final score in The cost category will be calculated in 2017, but it will not contribute to your MIPS final score until the 2018 reporting period. gehealthcare.com/cps 1 Threshold is likely to be announced ahead of start of reporting year. It is 3 for 2017.

2 MIPS Overview MIPS Overview Every year, each EC or group will receive an upward, downward or neutral payment adjustment based on a MIPS Final Score reflecting four categories: Quality Advancing Care Information Improvement Activities Cost Payment Year 2019 Payment Year 2020 Payment Year % 15% 15% 30% 25% 60% 25% 50% 25% 10% 30% NOTE: Cost is not included in the final score in payment year 2019.

3 How much can MIPS adjust payments? Each year, CMS will establish a performance threshold against which all eligible clinicians MIPS final scores will be compared to determine payments. By 2022, the highest performing ECs could see their payments increase by up to 9%. Those with lower MIPS scores could see their payments cut by up to 9%. In addition, the highest performing clinicians could receive an exceptional performance bonus of up to 10% in addition to any positive adjustments in payments. How Much Can MIPS Adjust Payments? Final Score Clinicians will receive +/ or neutral adjustments up to the percentages below +4% +5% Payment Year +7% +9% onward Adjusted Medicare Part B payment to clinician 4% 5% 7% 9% Maximum Adjustments Payment adjustment occurs in second year after reporting period. For example, adjustments for 2017 performance will take effect in Neutral payment adjustments ECs whose final scores are at the threshold will not receive a MIPS payment adjustment. Upward payment adjustments ECs whose final scores are above the threshold will receive positive payment adjustments up to 4% in 2019 to a maximum of 9% in 2022 and beyond. Downward payment adjustments In 2017, ECs whose final scores are below the threshold will receive negative payment adjustments up to 4% in 2019 to a maximum of 9% in 2022 and beyond. Exceptional performance bonus The top 25% of performers above the normal performance threshold will be eligible for an additional exceptional performance bonus up to 10%, in addition to the possible 9% positive adjustment, to be paid from a $500 million fund that MACRA has earmarked for these bonuses.

4 Payment Adjustment Factors For 2019 payment year based on 2017 reporting 100% ECs BELOW performance threshold have negative adjustment ECs ABOVE performance threshold have positive adjustment Payment Adjustment Factors for 2017 reporting year 0 4% Zero to 25% of performance threshold All receive 4% Additional Bonus Payment for Exceptional Performance Up to 10% ( ) Top 25th percentile of scores above the performance threshold MIPS Final Score Range Payment Adjustment Factors 100% Performance Threshold, 3 After reporting is compiled and scored, CMS will compare all scores to a performance threshold to determine payment adjustments. ECs below the threshold will get a negative adjustment. ECs at the threshold will get no adjustment. ECs above the threshold will get a positive adjustment. In 2017, all below threshold will get a 4% reduction. In addition, ECs scoring in the top 25% of scores above the performance threshold will be eligible for additional bonuses for exceptional performance.

5 MIPS Timeline Reporting of 2017 data is due March 31, 2018, with corresponding payment adjustments occurring in In general, data should be reported for at least 90 consecutive days, with some benefits from full year reporting for certain quality measures. The MIPS program will be periodically reviewed with feedback reports Performance Period (Jan-Dec) Reporting and Data Collection Deadline for Data Submission (March 31) Targeted Review Based on 2017 MIPS Performance MIPS Begins to Pay for Quality MIPS Timeline Analysis and Scoring

6 Performance Category Scoring Performance Category Maximum Possible Points per Performance Category Percentage of Overall MIPS Score (2017 Performance Year) Quality Clinicians choose six measures to report to CMS that best reflect their practice. One of these measures must be an outcome measure or other high priority measure if no outcome measure is applicable. CMS to also score up to one population measure from claims for qualifying groups. Advancing Care Information Clinicians must report on required base score measures to earn category credit. Performance scores are based on additional achievement in chosen measures above the base score requirements. Improvement Activities Clinicians can choose the activities best suited for their practice; the rule proposes over 90 activities from which to choose. Clinicians participating in medical homes earn full credit in this category. Cost (starting in 2018) CMS will calculate these measures based on claims and availability of sufficient volume. Clinicians do not need to report anything. 70 points 60% 100 points 25% 40 points 15% 10 points 0% Performance Category Scoring

7 How it Works: Calculating the Scores for Each Category MIPS Category Weight in performance year 2017 Scoring Quality 60% Each measure 1-10 points compared to historical benchmark of peers performance, if available; 3 point minimum if no benchmark; 0 points for a measure that is not reported. Bonus for reporting additional outcomes, patient experience, appropriate use, patient safety, care coordination and EHR reporting. Performance plus bonus points are added and divided by 10x the number of scored measures. Advancing Care Information Improvement Activities Cost (starting in 2018) 25% This category score is made up of base, performance, and bonus scores for a maximum score of 100 percentage points out of a pool of 155 available points. Clinicians need to fulfill the requirements of all base score measures in order to receive the 50 point base score. Performance scores (up to 90 points) are based on additional achievement above base score requirements on certain measures. Certain activities are also eligible for bonus scoring (up to 15 points). 15% Each activity worth 10 points; double weight for the 14 activities categorized as high value activities; sum of activity points compared to the target of 40 points in this category. Small practice (15 or fewer professionals), rural/health professional shortage area practices, non-patient facing MIPS EC: one high weight or two medium weight. Full credit for a recognized Primary Care or Patient Centered Medical Home or the equivalent. 0% 1-10 points based on performance period benchmark, which will be determined based on cost data from the performance period. Points are awarded in each measure depending on how a provider scored in relation to overall performance. How it Works: Calculating the Scores for Each Category MIPS uses a unified scoring system to determine payments: Converts measures/activities to points ECs will know in advance what they need to do to achieve top performance. Quality measures will be selected annually through a call for quality measures process, and a final list of quality measures will be published in the Federal Register by November 1st of each year. Moves away from all-or-nothing scoring partial credit available The Final Score method accounts for: Weights of each performance category Exceptional performance factors Availability and applicability of measures for different categories of clinicians Group performance Quality and Cost scores depend on an EC s performance relative to peers. Download our brochure about an EMR that helps you excel.

8 Tallying your MIPS Final Score The MIPS Final Score is a weighted sum of the points an EC has earned in each category. CMS will use the MIPS Final Score for performance year 2017 to determine an ECs upward, downward, or neutral payment adjustment for Quality Performance Component Quality Measures Points Earned (up to 70 points) Measure Bonus Points (up to 10% of possible points) CEHRT Bonus Points (up to 10% of possible points) Total Quality Points (capped at 70) Total Possible Quality Points (up to 70 Points) Quality Category Weight Advancing Care Information Performance Component Base Score (50 Points, must satisfy all to receive any ACI score) Performance Score (up to 90 Points) Population Health Bonus (up to 5 points) IA Bonus (up to 10 Points) Total ACI Points (capped at 100) Total Possible ACI Points (100 points) ACI Category Weight Improvement Activities Performance Component Total IA Points (capped at 40) Total Possible IA Points (40 points) Cost Performance Component IA Category Weight Tallying your MIPS Final Score Total Cost Points (up to 10 points) Total Possible Cost Points (10 Points) Cost Category Weight Total MIPS Final Score Quality Performance Component ACI Performance Component Improvement Activities Performance Component Cost Performance Component

9 Your Options for is a transition year for the MIPS program. ECs will be required to submit data by March 31, 2018, for payment adjustments for ECs participating in MIPS have four options: Don t Participate Submit Test Data Submit a Partial Year Submit a Full Year You ll receive a negative 4% payment adjustment. Using an ONC 2014 edition and/or 2015 edition certified EHR and a minimum amount of 2017 data (for example, one quality measure or one improvement activity for 90 days) will enable you to avoid a downward payment adjustment. Using an ONC 2014 edition and/or 2015 edition certified EHR and a minimum 90 days of 2017 data from all four performance categories will earn a neutral or positive payment adjustment. Use an ONC 2014 edition and/or 2015 edition certified EHR and a full year of 2017 data can earn a neutral or positive adjustment; some quality measures, such as certain outcomes measures and those with lower denominators, would benefit from full year reporting. Your Options for 2017

10 You Belong Here As your trusted advisor, GE Healthcare provides access at no additional cost to resources like the QPP Quality Reporting Guide and both live and on-demand webinars that describe how to succeed with MIPS overall and within each measure. When you partner with GE Healthcare, you can benefit from the knowledge and resources of the entire GE Healthcare community. For example, learn how others are adjusting to changing regulations through our interactive Quality Reporting Community on our Service Portal. Collaborate with GE Healthcare and other customers in answering questions, solving challenges, and leveraging best practices. GE Healthcare offers additional services 1 where consultants can also help improve your performance and payment outcomes. We can work with you to help you understand the requirements of MIPS and APM s, determine the measures that best meet your needs and goals selection, monitor progress, and facilitate reporting. In addition, we can also help you assess practice and Centricity Practice Solution workflows to ensure they enable accurate MIPS tracking and reporting. Ask us about our MIPS guarantee. Contact us for details on our MIPS guarantee and to learn how we can help you optimize your MIPS score. 2 Contents of this MIPS Scoring Guide were updated as of May 11, This is not legal advice. MIPS program rules are subject to change without notice. Always consult most recent rules before making a submission. For more information, visit CMS s Quality Payment Program website: 1. GE Healthcare offers additional Quality Reporting Service packages for a fee to help your organization successfully transition to MIPS. 2. MIPS Guarantee is available to customers of GE Healthcare s Premium Quality Reporting Service. Contact us for terms and conditions. Restrictions apply General Electric Company All rights reserved. GE Healthcare reserves the right to make changes in specifications and features shown herein, or discontinue the product described at any time without notice or obligation. Contact your GE Healthcare representative for the most current information. GE, the GE Monogram, and Centricity are trademarks of General Electric Company. GE Healthcare, a division of General Electric Company. GE Medical Systems Information Technologies, Inc., doing business as GE Healthcare. Centricity Practice Solution v12.2 and Centricity EMR v9.10 are certified ONC 2014 Edition compliant complete and modular EHRs. For additional certification and transparency information, visit JB49353US You Belong Here